Cost and Radiation Savings of Partial Substitution of Ultrasound for CT in Appendicitis Evaluation: A National Projection

Parker, Laurence; Nazarian, Levon N.; Gingold, Eric L.; Palit, Charles D; Hoey, Courtney L; Frangos, Andrea J.

doi:10.2214/ajr.12.9642

Cited by 54 publications

(44 citation statements)

References 18 publications

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“…Lower values of sensitivity and specificity can be explained by the use of enteral contrast [32, 33, 35–44]. However, the radiation exposure of abdominal CT is a concern particularly in children and during pregnancy.…”

Section: Pre-operative Carementioning

confidence: 99%

Diagnosis and management of acute appendicitis. EAES consensus development conference 2015

et al. 2016

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Unequivocal international guidelines regarding the diagnosis and management of patients with acute appendicitis are lacking. The aim of the consensus meeting 2015 of the EAES was to generate a European guideline based on best available evidence and expert opinions of a panel of EAES members. After a systematic review of the literature by an international group of surgical research fellows, an expert panel with extensive clinical experience in the management of appendicitis discussed statements and recommendations. Statements and recommendations with more than 70 % agreement by the experts were selected for a web survey and the consensus meeting of the EAES in Bucharest in June 2015. EAES members and attendees at the EAES meeting in Bucharest could vote on these statements and recommendations. In the case of more than 70 % agreement, the statement or recommendation was defined as supported by the scientific community. Results from both the web survey and the consensus meeting in Bucharest are presented as percentages. In total, 46 statements and recommendations were selected for the web survey and consensus meeting. More than 232 members and attendees voted on them. In 41 of 46 statements and recommendations, more than 70 % agreement was reached. All 46 statements and recommendations are presented in this paper. They comprise topics regarding the diagnostic work-up, treatment indications, procedural aspects and post-operative care. The consensus meeting produced 46 statements and recommendations on the diagnostic work-up and management of appendicitis. The majority of the EAES members supported these statements. These consensus proceedings provide additional guidance to surgeons and surgical residents providing care to patients with appendicitis. Electronic supplementary materialThe online version of this article (doi:10.1007/s00464-016-5245-7) contains supplementary material, which is available to authorized users.

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Section: Pre-operative Carementioning

confidence: 99%

Diagnosis and management of acute appendicitis. EAES consensus development conference 2015

et al. 2016

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“…Although CT is reported to have a higher sensitivity than US, ongoing concerns have been raised regarding radiation exposure and increased costs associated with CT scans [12] . Projections estimated that a solid cancer will result at a rate of 25.8 to 33.9 cases per 10,000 abdominal CT scans in girls and, 13.1 to 14.8 cases per 10,000 abdominal CT scans in boys [23] . Furthermore, high costs and the need for sedation would limit the use of CT and MRI for diagnosing appendicitis in children.…”

Section: Resultsmentioning

confidence: 99%

Combination of Alvarado score and ultrasound findings in diagnosis of acute appendicitis in children

Fakhry

Shawky

2017

J Pediatr Dis

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Appendicitis is the most common cause of emergency abdominal surgeries in children. Ultrasound (US) has been proven to be a helpful imaging modality in patient evaluation, especially in children suspected of appendicitis. The Alvarado score is a 10-point scoring system for the diagnosis of appendicitis based on clinical data and differential leukocyte count. The aim of the present study was to evaluate a combination of clinical scoring (Alvarado score) and US findings for accurate diagnosis of appendicitis in children. The study was done in Menoufia University Hospitals from March 2011 to January 2013. 322 children with abdominal pain clinically suspected of having appendicitis were included in the study and clinically assessed to calculate the Alvarado score. Patients were referred to the radiology department for abdominal US. Among the 153 of the 322 patients who were operated on, 149 patients were diagnosed pre-operatively with acute appendicitis and 4 girls were diagnosed with complex ovarian cysts. Of the 149 patients diagnosed with appendicitis, the percentage of appendicitis was 93% (139/149) and 10 (7%) patients had normal appendix. The prevalence of appendicitis among the patients of the study was 43% (139/322). In conclusion, a combination of Alvarado scores and abdominal US is a good approach for the diagnosis of appendicitis in children to reduce the number of laparotomies for normal appendix. In the case of normal appendix or nonvisualization of the appendix via abdominal US without a high Alvarado score, appendicitis can be safely ruled out. If it is proven as an inflamed appendix on US or a high Alvarado score, patient should be subjected for appendectomy without delay. Keywords

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“…They found that an ultrasound-CT protocol for appendicitis evaluation offers potentially large savings over the standard CT-only protocol [17]. In their analysis, the positive predictive value of ultrasound was 91 % compared with 92.5 % for CT scan (nonsignificant difference).…”

Section: Discussionmentioning

confidence: 97%

Impact of the alvarado score on the diagnosis of acute appendicitis: comparing clinical judgment, alvarado score, and a new modified score in suspected appendicitis: a prospective, randomized clinical trial

et al. 2014

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Background The Alvarado score is a clinical scoring system used in the diagnosis of acute appendicitis. This study aimed to compare the reliability of the Alvarado score and clinical judgment and to refine the score to make it easier to use. Methods In this prospective, randomized study, patients presenting at the authors' outpatient department with suspected appendicitis during a 1-year period were assigned in weekly alternation to either group A or group B. The group A patients were treated on the basis of their Alvarado score, and the group B patients underwent treatment based on clinical judgment. The correctness of the methods was assessed by evaluation of the final histology. Statistical comparison of the data was performed using SPSS 20. Results The study investigated 269 patients (131 in group A and 138 in group B). The groups were homogeneous in terms of mean age, gender, body mass index, and American Society of Anesthesiologists score. The number of negative appendectomies was 12 (9.16 %) in group A versus 5 (3.6 %) in group B (p = 0.063). The clinical judgment had better specificity and sensitivity than the Alvarado score. For that reason, the specificity of the Alvarado score was refined using statistical methods, with weighting of certain clinical data and inclusion of new ones (e.g., ultrasound investigation). Consequently, the area under the curve by receiver operating characteristic analysis gradually increased, and the Alvarado score became more accurate. Conclusion The study findings showed clinical judgment to be more reliable in the diagnosis of acute appendicitis than the Alvarado score, but the score is a useful diagnostic aid, especially for young colleagues. The use of the new scoring system has become easier. It includes fewer criteria as well as an important and sensitive predictor: the ultrasound investigation.Acute appendicitis is the most common urgent surgical condition, with 9 % of the population affected [1]. Its differential diagnosis is extremely difficult, especially for the elderly, children, and fertile-age women, in whom it can mimic numerous gynecologic and urogenital conditions [2]. The lethality of the condition is about 0.7 %, which means that it causes the death of almost 100 patients in Hungary each year [3]. Furthermore, the number of negative appendectomies remains in the approximate range of 5-10 %, although the negative appendectomy rate (NAR) has decreased in recent decades due to better diagnostic techniques (i.e., ultrasound and preoperative computed tomography [CT]) [4].The diagnosis of acute appendicitis is based on the medical history, the physical examination, and the laboratory analysis, but imaging techniques (ultrasound and CT scan) also may be helpful. The ultrasound scan is easy to perform and inexpensive, but its result is examiner-and patientdependent. With its help, however, the number of negative appendectomies can be decreased by 10 % [5]. The CT scan

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Cost and Radiation Savings of Partial Substitution of Ultrasound for CT in Appendicitis Evaluation: A National Projection

Abstract: An ultrasound-CT protocol for appendicitis evaluation offers potentially large savings over the standard CT-only protocol. There are moderate savings from using a less expensive imaging technique despite extra surgeries and large savings from radiation exposure avoided.

Cited by 54 publications

References 18 publications

Diagnosis and management of acute appendicitis. EAES consensus development conference 2015

Diagnosis and management of acute appendicitis. EAES consensus development conference 2015

Combination of Alvarado score and ultrasound findings in diagnosis of acute appendicitis in children

Impact of the alvarado score on the diagnosis of acute appendicitis: comparing clinical judgment, alvarado score, and a new modified score in suspected appendicitis: a prospective, randomized clinical trial

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